Diabetic Nephropathy Classification Developed

Classification includes four hierarchical glomerular lesions with varying severity degrees
By Jane Parry
HealthDay Reporter

FRIDAY, March 12 (HealthDay News) -- A new consensus on the classification of type 1 and type 2 diabetes-related nephropathy, dividing diabetic nephropathy into four hierarchical glomerular lesions with varying degrees of severity, may aid international clinical practice, according to an article published online Feb. 18 in the Journal of the American Society of Nephrology.

Thijs W. Cohen Tervaert, M.D., of Leiden University Medical Center in the Netherlands, and colleagues divided DN into four hierarchical glomerular lesions and evaluated degrees of interstitial and vascular involvement separately.

The researchers found that the classification of lesions ranges from Class I, where there is thickening of the glomerular basement membrane (GBM), and mild, isolated changes, through to Class IV, which is the classification for advanced diabetic glomerulosclerosis, where over 50 percent of evidence of renal disease can be attributed to diabetes.

"Little is known about the pathogenesis of lesions developing in DN, but it is suggested that if we could unravel the various pathways ultimately leading to glomerulosclerosis in DN, this could open up new possibilities for intervention to prevent or forestall nephropathy," the authors write. "We suggest that progression evolves from GBM thickening to mesangial expansion, Kimmelstiel-Wilson lesions, and global glomerulosclerosis, respectively, which is reflected in the four classes of our classification system."

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